摘要
目的 探讨经心尖-经导管主动脉瓣置换术(TA-TAVR)治疗不同射血分数的重度主动脉瓣关闭不全患者的疗效。方法 回顾性分析2017年11月至2023年1月在新疆维吾尔自治区人民医院行TA-TAVR的重度主动脉瓣关闭不全患者的临床资料。将左心室射血分数(LVEF)≥50%的重度主动脉瓣关闭不全者纳入射血分数保留组,将LVEF<50%的重度主动脉瓣关闭不全患者纳入射血分数降低组,分析两组患者的临床资料。结果 共纳入60例患者,射血分数保留组24例,射血分数降低组36例。两组患者术后1 d的主动脉瓣口反流容量均较术前显著改善,射血分数保留组患者的左心室重构(LVR)指标[左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESD)、左心室后壁(LVPW)、LVEF]于术后1 d即显著改善,之后保持相对稳定;射血分数降低组患者LVR指标的改善于术后3个月才得以显现;两组患者术后3个月N末端B型脑钠肽前体(NT-proBNP)水平较术前降低,射血分数保留组患者之后保持稳定,射血分数降低组患者术后12个月较前升高;射血分数降低组患者12个月内心力衰竭再入院率高于射血分数保留组患者,欧洲三水平五维健康量表健康效应值(EQ-5D-3L)平均得分、整体健康感知(EQ-VAS)平均得分均低于射血分数保留组患者;两组患者术后12个月心房颤动发生率、三度房室传导阻滞发生率、永久起搏器植入率、脑卒中发生率、瓣叶血栓发生率、瓣周漏发生率、生存率、部分药物使用情况的比较,差异均无统计学意义(均P>0.05)。结论 TA-TAVR可有效解除不同射血分数的重度主动脉瓣关闭不全患者的主动脉瓣反流、促进左心室逆重构,且射血分数保留组患者TAVR术后的预后更佳。随着心功能的进一步下降,TAVR术后的预后也逐渐变差,因此对于射血分数保留的主动脉瓣关闭不全患者应该尽早进行干预,避免出现因心功能的进一步恶化后再行手术治疗的预后不佳,以期达到最佳的预后。
Objective To explore the efficacy of ransapical-transcatheter aortic valve replacement(TA-TAVR)in patients with severe aortic regurgitation(AR)with different ejection fraction.Methods The clinical data of patients with severe AR undergoing TA-TAVR from November 2017 to January 2023 were retrospective reviewed,severe AR patients with left ventricular ejection fraction(LVEF)≥50%were included in the ejection fraction preserved group and patients with severe AR with LVEF<50%were included in the reduced ejection fraction group.Clinical data of the patients in group 2 were analyzed.Results A total of 60 patients were included,including 24 in ejection fraction preserved group and 36 in reduced ejection fraction group.All group had significantly improved aortic regurgitation volume 1 day after surgery compared with preoperative volume.The left ventricular remodeling(LVR)indexes[left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall thickness(LVPW),LVEF]improved significantly at 1 day after surgery,and remained relatively stable thereafter.The improvement in LVR in reduced ejection fraction group patients was only 3 months after surgery.Two groups of patients had a decrease in amino-terminal probrain natriuretic peptide(NT-proBNP)levels three months after surgery compared to before.Patients in ejection fraction preserved group remained stable thereafter,while patients in reduced ejection fraction group had an increase one year after surgery compared to before.The one-year heart failure rehospitalization rate in reduced ejection fraction group was higher than that in ejection fraction preserved group,and the mean scores of EQ-5D-3L and EQ-VAS were lower than those of patients in ejection fraction preserved group.Comparison of the incidence of atrial fibrillation,third degree atrioventricular block,and permanent pacemaker implantation rate,stroke incidence,leaflet thrombosis incidence,paravalvular leakage incidence,and survival rate,the usage of some drugs at 1 year in both group,there was no statistically significant difference(all P>0.05).Conclusions TA-TAVR can effectively relieve aortic regurgitation in severe AR patients with different ejection fraction and promote left ventricular reverse remodeling.Intervention in patients with severe AR with preserved ejection fraction should be performed as early as possible.
作者
孔璨
郭自同
祖丽皮耶姆·希尔
彭辉
KONG Can;GUO Zi-tong;Zulipiyem·Xier;PENG Hui(Heart and Vascular Medicine Diagnosis and Treatment Center of Xinjiang Uygur Autonomous Region People’s Hospital,Urumqi 830000,China)
出处
《中国介入心脏病学杂志》
CSCD
2024年第10期569-575,共7页
Chinese Journal of Interventional Cardiology
基金
自治区重点研发计划项目(2022B03009-3)。
关键词
主动脉瓣关闭不全
经导管主动脉瓣置换术
心功能
Aortic valve regurgitation
Transcatheter aortic valve replacement
Cardiac function
